A Nevada Health Plan - Without the Insurance

Thousands of people in the state won’t be covered under the federal health law. But there is another option. A health care network connects people without coverage to health care, without going through insurance companies.

Rice made a diagram of major community institutions - hospitals, government, bankers. She thought they can all be part of creating a new health care model: a medical discount plan.

"I asked everyone to do something." - Sherri Rice

“I started by asking the hospitals for the rates. I asked the uninsured to pay cash at the time of service plus a membership fee. I asked the providers to lower their rates. I asked the government to put money in to help sustain the network. I asked everyone to do something,” recounts Rice.

Rice’s vision is now a non-profit with dozens of staffmembers and a central office in Reno.

It’s calledAccess to Healthcare Network. Twelve-thousand uninsured Nevadans can be connected to two thousand providers offering everything but transplants at discounted rates.

A $35 monthly fee also pays for coordinators to help navigate the system.Doctors get paid by their patients at the time of service. Rice calls it a shared-responsibility model.

Everybody contributes something, but no one group is overburdened.

“Our rules are very strict for our members. Two 'no calls, no shows' to any of our providers, any non-payment – any non-payment – and I kick them out of this network and they can’t ever come back,” says Rice.

Rice says these uninsured people are not slackers - about two-thirds of them are employed. And through the network, they get a window into the health care system everyone else experiences, except – insurance companies are out of the picture.

A HEALTH PLAN WITHOUT THE INSURANCE

Sixty-two year old member Shelley Toreson likes it that way. She’s had a lot of medical care through the network over the past four years, and has a thick folder of medical paperwork.

"I had a healthcare insurance that I was paying and the cost just kept going up and the coverage kept getting less," says Toreson.

Toreson said she finally had to drop her health insurance. She says she filed bankruptcy in part because of medical debt. She said when she had insurance, medical costs always caught her off guard. But not now.

“Like right now I need a mammogram, well I know the cost upfront and I know that’s all there’s going to be and I’m happy with that," says Toreson.

Toreson recently had gall bladder surgery through the network. She borrowed a little less than $1,700 from family and friends. And she waited about three weeks to get the surgery. Her care coordinator helped her.

“They’re so willing to work with you on whatever kind of problem you might have. Whereas I think the health insurance… Anytime you call an insurance company, their first thing is 'how are we not going to pay this?' You know?” Toreson asks.

HOSPITAL TAKES 'ACCESS' PATIENTS TO PREVENT EMERGENCY CARE

Toreson had her surgery at St. Mary’s regional medical center in Reno. CEO Helen Lidholm says they’re happy to take uninsured patients through the Network.

“This is an organization that are really taking the the poor, and many of them disenfranchised, and giving them an opportunity to participate in such an important aspect of life – your own health care,” says Lidholm about the Access to Healthcare Network.

Lidholm says the medical discount model for the uninsured only works because the hospital has a mix of other revenue from private and public insurance. She says it takes a loss from discounted surgeries like Toreson’s gall bladder procedure.

“It was a good deal. Could we afford to do that for everyone that walks through the door? No,” says Lidholm.

But she says giving care to the uninsured before it reaches an emergency saves everyone the higher cost of urgent care. And Lidholm says the network does a good job at keeping their members out of urgent situations.

“Access to Health Care Network has the lowest E.R. utilization of any payer that I work with. And that’s remarkable, ” says Lidholm.

Sherri Rice says other states are looking at the network’s model of providing care to the uninsured. She says it’s simple – just bring the community together.

CHANGES UNDER THE AFFORDABLE CARE ACT

Under the Affordable Care Act, two thirds of the access members will become insured, and will therefore drop their membership.

But there will still be people who fall through the cracks in ObamaCare - undocumented people, and people who are priced out of the exchange. That population is expected to stay in the Network.

The Access to Healthcare Network will also be partnering with an insurance company to provide care coordination and health coaching for their policyholders.